Chest Discomfort and Heart Rhythm Issues in Teens

Cardiac thoracic issues?

Hello Doctor, I would like to inform you that I am currently 16 years old.
About 4 to 6 months ago, I began experiencing chest tightness.
I have seen multiple doctors and had X-rays taken, which the doctors said looked fine.
Later, I went to a pediatric cardiologist where I underwent an echocardiogram, an electrocardiogram (ECG), and a 24-hour Holter monitor.
The echocardiogram and ECG showed no issues, but the 24-hour Holter monitor detected some instances of arrhythmia.

I have a history of allergies and had blood tests done, which confirmed that I am allergic to dust mites.
The doctor mentioned that my allergies might be related to the chest tightness.
Recently, I have also felt occasional sharp pains in my left chest, but they last less than a second and are infrequent—perhaps no more than five times a day, and sometimes I go a week without experiencing them.
I received my first dose of the BNT vaccine on October 16, but I am unsure if it is related to my symptoms.

Currently, my condition is manageable, but the chest tightness persists occasionally.
Additionally, I may be experiencing nasal congestion due to my allergies, which causes loud breathing and a feeling of chest pressure.
I am wondering if, at my age, I can see an adult cardiologist or if there are other tests I should consider.

Overall, my symptoms include ongoing chest tightness that is not frequent, occasional arrhythmia detected by the 24-hour Holter monitor, and issues with nasal congestion that may lead to some difficulty breathing—not in the sense of not getting air, but rather that my nasal congestion makes breathing less smooth.
Sometimes both nostrils are completely blocked, forcing me to breathe through my mouth or requiring significant effort to breathe through my nose.

I monitor my blood pressure daily, which is generally around 100-110 for systolic and 50-60 for diastolic, with instances of it dropping as low as 47.
My heart rate during the last 24-hour Holter monitor test was about 40 beats per minute while I was sleeping, which seems slow.
Typically, my heart rate is around 50 beats per minute, occasionally reaching the 60s.
Given my current situation, do you have any recommendations? Thank you.

K, 10~19 year old female. Ask Date: 2021/11/14

Dr. Wu Xueming reply Cardiology

Based on your symptoms, it is recommended to visit a cardiology clinic for further evaluation.

Reply Date: 2021/11/14

More Info

It's understandable to feel concerned about your symptoms, especially at your age. Let's break down your situation regarding chest discomfort, heart rhythm issues, and the potential links to your allergies and overall health.

First, it's important to recognize that many young people experience episodes of chest discomfort and heart palpitations, which can often be attributed to a variety of factors, including anxiety, stress, and even physical activity. Given your history of allergies and nasal congestion, it's plausible that these could contribute to your feelings of chest tightness or discomfort. Allergies can lead to inflammation in the airways, making breathing feel more laborious, which might be perceived as chest discomfort.

You mentioned that you have undergone several tests, including X-rays, echocardiograms, and 24-hour Holter monitoring, which have largely returned normal results. This is reassuring, as it suggests that your heart structure and function are likely healthy. However, the detection of occasional arrhythmias during the Holter monitoring indicates that your heart rhythm can be irregular at times. In many cases, especially in younger individuals, these irregularities can be benign and not indicative of any serious underlying heart condition.

The occasional sharp pain in your left chest that lasts less than a second and occurs infrequently is also likely not a cause for alarm, especially since it resolves quickly and does not seem to be associated with exertion or other concerning symptoms. It's common for young people to experience transient chest pains that can be related to muscle strain, anxiety, or even gastrointestinal issues.

Regarding your blood pressure readings, it’s worth noting that blood pressure can vary significantly throughout the day and can be influenced by factors such as stress, hydration, and physical activity. A systolic reading in the low 100s with a diastolic reading in the 50s or 60s can be considered on the lower side, especially if you have experienced readings as low as 47. If you feel dizzy or lightheaded, it would be advisable to discuss this with a healthcare provider.

Your heart rate during sleep being around 40 beats per minute is considered bradycardia (a slower than normal heart rate). While this can be normal for some individuals, particularly athletes or those who are very fit, it’s important to ensure that it’s not causing you any symptoms such as dizziness or fainting. If you are experiencing symptoms, it would be prudent to consult a cardiologist.

In terms of your next steps, here are some recommendations:
1. Follow-Up with a Cardiologist: Since you have experienced some irregular heart rhythms and have concerns about your symptoms, it would be wise to consult a cardiologist who specializes in adolescent health. They can provide a more tailored assessment and determine if further testing is necessary.

2. Manage Allergies: Since you have a known allergy to dust mites, consider discussing with your doctor about effective allergy management strategies. This may include antihistamines or nasal sprays that can help alleviate your nasal congestion, potentially improving your breathing and reducing the sensation of chest tightness.

3. Monitor Symptoms: Keep a diary of your symptoms, noting when they occur, their duration, and any associated activities or stressors. This can help your healthcare provider identify patterns and triggers.

4. Lifestyle Adjustments: Engage in regular physical activity, maintain a balanced diet, and ensure adequate hydration. These lifestyle factors can significantly impact your overall cardiovascular health and well-being.

5. Stress Management: Since anxiety can exacerbate physical symptoms, consider incorporating relaxation techniques such as deep breathing exercises, yoga, or mindfulness practices into your routine.

6. Regular Check-Ups: Continue to have regular check-ups with your healthcare provider to monitor your heart health and any other concerns.

In conclusion, while your symptoms may be concerning, the tests you've undergone suggest that your heart is functioning well. However, ongoing monitoring and a proactive approach to managing your allergies and stress will be beneficial. Don't hesitate to seek further medical advice if your symptoms change or worsen.

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